Vitals Signs Monitoring in the Field

One of the more exciting EMS products I have seen lately is the new Propaq LT Vital Signs Monitor from Welch-Allyn (to view webpage click link, select country, then hit SUBMIT button to view). Welch-Allyn is a great family owned company, who several years ago bought MRL Defibrillators, and Protocol Systems. Both of these leading edge companies offered high quality technology combined with a history of innovation and market leadership. Under the Welch-Allyn banner both have moved forward to bring several new technologies to the EMS market. I have been a longtime personal fan of Welch-Allyn.

They simply make great quality products. I still carry my old Welch-Allyn Guedel Laryngoscope Blade, and trust it over anything else when the chips are down. I will not take a manual BP without a Welch-Allyn made Tycos brand BP cuff. Ambulance agencies often rely on very inexpensive stethoscopes and blood pressure cuffs. I see many who will spend a small fortune on a fancy light bar, but won’t spend more than 15 bucks on a BP cuff. Then they want to know why the ER Nurses don’t trust them, when they roll in with incorrect vital signs.

The Propaq LT is very compact and lightweight at less than 2 pounds, yet designed with the rigors of the pre-hospital care environment in mind. The device is has a 75G force limitation, exceeding the durability of almost any electronic device ever produced for EMS use. It offers the proprietary Propaq Motion Tolerant BP Technology in their Non-Invasive Blood Pressure feature. This means that the device can weed out motion artifact induced errors. My experience tells me this will be a very popular product. They even offer a package of the Propaq LT combined with an AED for BLS. Never before has this level of technology been offered to such a broad range of clinical care providers. It will mean many EMT’s need to learn a little more about the benefits and challenges of continuous vital signs monitoring.

Note; Another adaptation of this technology is the Mobile Acuity Workstation, developed for military & homeland defense applications. It gives you a mobile monitoring station capable of monitoring vitals on many patients simultaneously and wirelessly.

The first thing EMT’s need to know about vital signs monitoring is – Always Take Your First BP Manually. No matter how good the device, you need to get a manual base line first. It can tell you a lot about the patient’s condition beyond the BP itself. For example, you can hear heart irregularities as the systolic pressure presents. You can tell if the heartbeat is weak or strong. You can hear if the pulse is fast or slow. In only a few heartbeats, you can hear the signs of real problems early enough to react quickly. Also when the initial manual reading is very similar to those that the monitor produces, you know you can have real confidence in the ongoing readings from the device.

The real value of these devices is to take readings much more frequently, and to note changes in these readings earlier than manual methods would allow. I will say it again for emphasis, the reason you monitor vital signs is not to make them easier to get, it is to help you get more of them!

Most vital signs monitors have alarms, which are not really put there for EMS users. Offering one version of a device for different types of end users is much more efficient to manufacture. The real purpose of Alarms is to alert someone outside the patient’s room of a change in condition. You can just turn them off in the field, unless both caregivers elect to ride in the front leaving the patient alone in the back (not recommended). Sometimes they can annoy more than inform.

Another benefit is the monitors memory. The Propaq LT can remember 20 full value sets of multi-parameter vital signs. This is great for more accurately reconstructing the call when charting. No more transcribing from the notes on your arm, or scrawled on 4 x 4′s.

How diligent are you in taking regular vital signs? I have often been satisfied documenting just two sets on the way to the hospital. By taking more frequent and complete sets of vital signs, a good monitor can give you the chance to spot trends early. This gives you the opportunity to treat important changes in your patients status before they become life threatening. Many ALS Providers have already learned the advantages of multi-parameter monitors, that they now have built into their defibrillators. Critical Care Transport Teams, won’t leave home without ‘em. The Propaq LT will bridge the gap in what is available for ALS Providers still using basic defib/pacers, and EMT’s looking for a solution at their level of care.

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About Dan White

I'm a retired Paramedic and EMS Instructor with 35 years EMS and emergency medical product experience. I love canoes, cars and EMS. I write about EMS Technology on the Paramedic Blog, the Insights on Innovation column for EMS1.com, on AmbulanceWorld.com and Multibriefs.com. I work for Intersurgical, Inc. managing EMS sales and distribution. I can be reached directly at 573-240-0002. Follow me @Paradan on Twitter
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7 Responses to Vitals Signs Monitoring in the Field

  1. Nae says:

    This is good to know.  We were given CHEAP stethoscopes and NO BP cuff to carry with us.  You can\’t hear through the stethoscope in a quiet room … well, you can if the heart is strong.
     
    Suggestions for make and model of those pieces of equipment?  I don\’t want to go broke, but I sure want to have a kit that is going to get accurate vitals.
     
    ALSO — what do you believe should be carried in every EMT\’s car?
     
    Thanks for the GREAT lessons!
     
    God bless you and keep you,
     
    Nae  :o)

  2. Dan says:

    Dear Nae,

    These are highly personal choices. I confess I am very
    particular about my personal EMS Gear. You could easily spend $350.00-$500.00
    to build a real good, first quality Personal Responder Kit. I would start a
    little at a time. First get your own good stethoscope, and then later add a
    sphygmomanometer, followed by personal bag. Then you fill the bag a little at a
    time. By doing this in pieces you will be able over time to build a high
    quality system that will serve you well for years. Try to resist the temptation
    to buy a “stocked” personal bag. Typically the bag and components are all very
    inexpensively manufactured. Like anything else, you generally get what you pay
    for.

    Stethoscopes

    The best is PureTone Cardiology
    – (engineered by Bose Labs). There is also nothing wrong with a Littman
    Stethoscope or Ultrascope.

    Best under $100 is the PureTone Traditional Single Tube, or new single sided Mentor

    Economy Choice – Consider new DRG Symphony or Littman
    Classic for decent performance on a budget.

    Sphygmomanometers

    The Best is the Tycos® Classic Pocket Aneroids or the Tycos® Classic Style Hand Aneroid

    Best under $50.00 Economy Tycos Durashock

    The Best Compact Personal Responder Kit under $150.00My Favorite is the Propak Offroad Kit

    My Favorite Ventilation Device is the W.P.R.

    My Favorite Hand Suction is the SpiritMD Suction Easy

     Once you have your own Basic Diagnostics, First
    Responder Bag, and ABC stuff, you can usually get your home squad to “donate”
    the rest to you over time. Don’t try do carry everything; focus on what you
    might need in the first 15 minutes of care. This will largely be Airway,
    Ventilation, Bleeding, Burns, Personal Protection and Shock focused supplies.

  3. Nae says:

    Dan ~
     
    Thank you for the GREAT information.  I will get the good equipment one piece at a time as you have suggested.  I have checked out all the sites, and will now go see my cardiologist "brother" and see if he has any connections so the cost can be reduced.
     
    God bless you and keep you,
     
    Nae  :o)

  4. Candy says:

    We are looking for a better vital signs monitor that can take the movement in the ambulance. Have you experienced any problems especially with movement or not getting readings with this Pro paq you ate talking about? Any help would be appreciated!
    Thanks

  5. Connie Pena says:

    What is the relation of hypertension and risk for decrease cardiac output?

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